Creative Education, 2010, 1, 25-32
doi:10.4236/ce.2010.11005 Published Online June 2010 (
Copyright © 2010 SciRes. CE
Using Problem Based Learning in Training Health
Professionals: Should it Suit the Individual’s
Learning Style?
Tsameret Ricon, Sara Rosenblum, Naomi Schreuer
Department of Occupational Therapy, University of Haifa, Haifa, Israel.
Received December 24th, 2009; revised March 20th, 2010; accepted April 8th, 2010.
Context: Recently, problem-based learning (PBL) methods have been incorporated into occupational therapy (OT) cur-
ricula as in healthcare curricula worldwide. Yet, most studies examining the effectiveness of these methods have not
taken into account the individuals’ learning style and occupational functioning, despite of their importance. Objective:
Our research examined the question of whether specific learning styles correlate with a higher self-evaluation by oc-
cupational therapy students of their occupational functioning (learning, studying) during a new course incorporating
PBL method and with greater course satisfaction. Methods: 40 female students took part in the study. The various
learning demands in the new PBL course are described. We assessed students’ learning styles using Felder’s Index of
Learning Styles, while Self-Assessments of Occupational Functioning (SAOF) provided learning outcome data. We used
both a modified 23-item SAOF and a novel 26-item adapted version, to examine the occupational functioning required
of healthcare practitioners. Course satisfaction was assessed accordingly. Results: Occupational therapy students
adopt all learning styles (sensing, intuitive, visual, verbal, active, reflective, sequential, and global) equally. Neverthe-
less, two-tailed Pearson’s tests revealed that a sensing (i.e. practical, facts-oriented) learning style most strongly cor-
relates with greater assessed occupational functioning in the areas of habituation and performance, e.g. time organiza-
tion, routine flexibility, and communication (r = 0.33, p < 0.05). An intuitive learning style correlates with a significant
ability to identify problems (r = 0.35, p < 0.05) and set goals (r = 0.36, p < 0.05), and global learning style yielded
greater course satisfaction (r = 0.56, p < 0.05). Conclusions: Students having sensing and intuitive learning styles gain
most from the use of PBL method. Thus, the apparently contradictory findings of earlier research regarding the efficacy
of PBL methods may have arisen from differences in the learning styles of the populations surveyed. Since problem-
based and traditional teaching methods appear to suit different learning styles and to better impart different skill sets,
they should be regarded as complementary.
Keywords: Healthcare Education, Teaching Methods, Occupational Therapy, Occupational Performance (Functioning)
1. Introduction
The question of what constitute the best methods for
educating healthcare professionals in a rapidly changing
environment is the subject of worldwide debate [1-5].
Researchers and educators are aware of the need to use
diverse teaching methods to improve the abilities of stu-
dents with varied individual characteristics and needs [6].
Thus, over the past 30 years, teaching methods and edu-
cational programs designed in a problem-based and
learner-centred manner have become common in medical,
nursing, and health services curricular [3,7]. They have
also been introduced into occupational therapy programs
as an adjunct or alternative to the traditional didactic,
classroom-based model of teaching [8-10].
The central and common characteristic of most defini-
tions of problem-based learning (PBL) is the use of
problems to enhance learning [9] so that the problems or
cases stimulate students to search and build the most ap-
propriate solution for their clients, challenged by team
and a faculty facilitator [6,8]. Students must motivate
themselves and take responsibility for seeking out the
relevant information, and for raising problems, questions,
or dilemmas that are the impetus for the ongoing learning
process [6].
Studies on PBL that have taken place in a medical
Using Problem Based Learning in Training Health Professionals: Should it Suit the Individual’s Learning Style?
teaching context; have focused mainly on its effective-
ness in comparison to the conventional teaching method
in terms of: the academic performance of the learner
[11-13], self-rated competencies, academic and clinical
outcomes [14]. Although students generally prefer PBL
methods over conventional instruction [9], numerous
studies have yielded contradictory results in terms of the
academic and clinical proficiency of students taught us-
ing problem-based learning methods compared to tradi-
tional didactic teaching [9,12,15,16].
The use of PBL in the occupational therapy context
has yielded similarly inconclusive results. Thus, Reeves
and his colleagues [17] found that, although a majority of
newly qualified occupational therapists indicated that
PBL equipped them well for their upcoming clinical
practice, some graduates were more sceptical and viewed
PBL as having a limited effect on their problem solving
abilities, clinical knowledge, and skills. Other studies
have focused on students’ subjective evaluations of im-
provement in various areas, such as group skills [18] and
clinical reasoning [19], as a consequence of problem-
based learning demonstrating variability in the benefits
ascribed to the PBL method [20].
The current study hypothesis was based on two main
theoretic models: The Model of Human Occupation [21,
22] and Felder and Silverman’s model of learning styles
Students’ learning styles were assessed according to
the Felder and Silverman model [24,25]. According to
Felder, a learning style reflects the individual’s charac-
teristics, strengths and preferences in the ways he or she
processes information [26]. Learning styles vary from
one individual to another. They indicate a person’s predi-
lections on five continua: sensing/intuitive, visual/verbal,
inductive/deductive, active/reflective, and sequential/global,
which are formalized into the Index of Learning Styles
The Model of Human Occupation (MOHO) [21] was
borrowed to examine the student as a person/individual
performing a learning occupation. The MOHO describes
three interrelated human characteristics relative to occu-
pational functioning: volition (motivation, decision), ha-
bituation (behavioural patterns and routines), and per-
formance capacity (the physical cognitive and mental
abilities). The MOHO provides the theoretical back-
ground [21], to the Self Assessment of Occupational
Functioning which has being used in the current study as
a means to self evaluate the students’ strengths and
weaknesses relative to their occupational functioning as
learners in the new course.
Thus, the question arises as to whether problem-based
learning is suited only to individuals with certain learn-
ing styles. Yet, the issue of the effectiveness of PBL for
students exhibiting different learning styles has not been
the focus of research to date. Consequently, we posed the
following research question:
Do certain learning styles correlate with OT students’
higher self-evaluation of performance and greater course
satisfaction, during a new course aiming to prepare them
for the transition from theory to practice, using problem-
based learning method?
2. Methods
2.1 Participants
All third year students studying for a Bachelor’s degree
in occupational therapy in the University of Haifa during
the 2004-2005 academic year chose to enrol in a new
problem-based learning course and agreed to participate
anonymously in this study. All students [48] were female,
43 (90%) were non-immigrant students while 5 (10%)
were immigrants; 5 (10%) were single, and 29 (60%) had
an urban background. Mean student age was 25.3 years,
with a standard deviation of 1.5 years, which is repre-
sentative of the local national undergraduate student
population. Forty students (83.33%) signed the consent
form and participated anonymously in the study.
2.2 The “Intervention along the Life Span”
The constant independent variable for all students in this
study was their participation in a new course called “In-
tervention along the Life Span”, which was established
using PBL principles.
Three experienced occupational therapy teachers con-
ducted the course, which ran for 12 intensive weeks and
comprised of three parallel processes: The first process
was three introductory lessons for the whole class (N =
48); the second was an on-going class-work performed in
groups (N = 16) and teams (N = 4) whose purpose was
interactive learning process with feedback provided by
the peers; and the third was individual weekly meetings
between each student and her client in the community.
The final lesson (12th) served for, integrating the different
processes into a whole intervention experience. From the
fourth lesson on and parallel to the class-based learning,
the students began to meet their clients in the community.
Over the course of several meetings, each student was
required to set an occupational goal and objectives with
her client and apply a short term intervention. This major
goal was accompanied by problem based methods and
multi-interactions, supported by the teacher and the peers,
along with: gather information in terms of the client’s
occupational performance and environment; search the
literature for further knowledge about the client’s needs
and theoretical frameworks; discuss treatment barriers
and facilitators with the client; and develop options for a
subsequent short-term intervention. These aspects of the
course design aimed at avoiding a common weak-point
of PBL courses, which struggle to generate appropriate
Copyright © 2010 SciRes. CE
Using Problem Based Learning in Training Health Professionals: Should it Suit the Individual’s Learning Style?27
real problems upon which to base the learning (i.e. using
written case studies). The approach we adopted ensured
the natural creation of sub-goals and required students to
seek a wide-range of information. The on going counsel-
ling and team supervision ensured a constructive process,
accompanied by variety of media, including videos,
presentations, a course web-site, and role simulations
The students were also required to document the entire
process in a diary, to present their client to their team
along each stage of the intervention plan, and to relate to
feedback from their teams. The role of the course tutors
was to facilitate independent learning (i.e. to facilitate
group discussions, point out dilemmas, suggest new
thinking directions and reflect personal progression or
obstructions). At the end of the course, each student pre-
sented the process she had undertaken with the client to
her 16-student group and submitted a comprehensive
written assignment to her tutor. A variety of media were
used in all course contexts, including videos, presenta-
tions, a course web-site, and role simulations.
2.3 Research Tools
2.3.1 The Index of Learning Styles (ILS)
Students’ learning styles were assessed according to the
Felder and Silverman model [24,25]. The Index of
Learning Styles [ILS; 24,26,27] consists of four scales.
Each scale comprises 11 items and, for each item, the
learner is asked to choose between two dichotomous
learning styles that suit him/her in various situations:
sensing (concrete, practical, oriented towards facts) or
intuitive (conceptual, innovative, oriented towards theo-
ries); visual (prefers visual representations of presented
materials) or ver ba l (prefers written or spoken explana-
tions); active (learns by trying things out) or reflective
(learns by thinking things through); and sequential
(adopts a linear thinking process, proceeds in incremental
steps) or global (adopts holistic thinking, progresses in
large leaps) [27]. The higher the value of the score in
each of the four scales, the closer a person is to the
first-mentioned term in each pair of styles.
The validity and reliability of this index has been ex-
tensively examined among many diverse student popula-
tions, including those surveyed in this research [27-30].
An acceptable alpha Chronbach value was found for the
Sensing-Intuitive and Visual-Verbal scales ( = 0.70),
while lower alpha values were found for the Active-Re-
flective ( = 0.60) and Sequential-Global ( = 0.56)
scales [27]. However, differences were found between
genders and between engineering compared to liberal arts
and education students by two-way ANOVA, using
post-hoc tests for each of the four scales [27]. As a result,
three problematic items (#30, #40 and #42) were ex-
cluded from the revised 41-item version of the ILS [31]
that we used for this research.
The students’ scores on each of the four sub-scales
constituted the learning styles variable for the current
study. Internal reliability was confirmed by factor analy-
sis, which yielded a strong Cronbach’s alpha for the 41
item ILS ( = 0.85).
2.3.2 Self Assessment of Occupational Functioning
The original purpose of the adult version of the revised
Self Assessment of Occupational Functioning [SAOF; 32,
33] was to provide a tool for collaborative client-centered
goal setting facilitated by the occupational therapist. The
assessment enables individuals to evaluate their per-
formance on 27 items in a framework that helps to iden-
tify challenges to performing desired roles, prior to the
clinical goal-setting process. In the assessment, the sub-
ject (14 to 85 years old) is asked to grade his/her per-
formance in each item on a three point performance scale:
“strong” (3), “adequate” (2), or “requires improvement”
Henry et al. [33] adapted the tool for use in assessing
the occupational performance of students as learners. The
student-adapted SAOF has been established as a reliable
and useful tool for self evaluation by students of their
performance [33,34].
We therefore used the student-adapted SAOF [33] to
collect data from our students regarding their perform-
ance in the new problem-based learning course. Four
items were deleted from the SAOF questionnaire ( #5, #6,
#20, and #21; see Table 1), due to low variance and
missing data. The 23 remaining items showed a signifi-
cant division into two primary factors, as confirmed by
Cronbach’s alpha, namely: Volition and a united Ha-
bituation & Performance factor (Table 1). No significant
effects were found for the original single-item Environ-
ment factor, which is consistent with the findings Henry
et al. [33], and we therefore omitted it from further
analysis. This analysis, confirms the basic structure of
the 23-item SAOF questionnaire, its content validity, and
its relevance to our study. The total score on the 23-item
SAOF constituted the first performance outcome meas-
ure for this study.
The healthcare sector places particular emphasis on
students’ abilities to define operative goals for clients
and for themselves, and this was certainly a strong theme
in our new course. Yet goal-setting abilities do not fea-
ture strongly in the 23-item SOAF, which includes only
one question within this issue (item #24; identifying
problems and their solutions). We therefore added three
items to the 23-item SAOF: “setting goals suitable for the
client” (item 28), “Implementing client’s goals” (item
29), and “applying my own goals” (item 30) (Table 2).
Chronbach’s alpha confirmed that these 3 items formed
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Using Problem Based Learning in Training Health Professionals: Should it Suit the Individual’s Learning Style?
Copyright © 2010 SciRes. CE
Table 1. Self assessment of occupational functioning (SAOF)1, (N = 40)
Factor Items Cronbach’s Alpha Mean SD
1. Sub-total (23 items) 1-4, 7-19, 22-27 α = 0.77 2.11 0.27
2. Goal setting (3 new items added for current study) 28-30 α = 0.76 2.06 0.50
3. Grand total (26 items) 1-4, 7-19, 22-27, 28-30 α = 0.79 2.09 0.27
SAOF Factors
1.a. Volition factor (11 items) 1-4, 7-13 α = 0.67 2.21 0.35
1.b. Habituation & Performance factor (12 items) 14-19, 22-27 α = 0.69 2.09 0.33
Deleted items 5, 6, 20, 21
1The Self-Assessment of Occupational Functioning (SAOF) used in this study comprised 23 items from Baron and Curtin’s original 26-item SAOF
[25] plus 3 new “goal setting” items added for the current research. In addition the factors and the deleted items are presented
(5-“Staying with a frustrating Activity”; 6-“Making my own decisions”; 20-“Expressing myself to others”; 21-“Socializing with another person”).
Table 2. Scores for the factors of the 26-item SAOF1 and for the course satisfaction questionnaire
N Mean Range SD
Volition 40 2.21 1-3 0.34
Habituation & Performance 40 2.09 1-3 0.33
Goal setting 40 2.05 1-3 0.50
Satisfaction with the course 16 4.13 1-5 0.58
Satisfaction with the teacher 16 4.76 1-5 0.37
1The 26-item Self-Assessment of Occupational Functioning (SAOF) comprised three factors: volition, habituation & performance, and goal setting
an additional “goal setting” factor within our 26-item
SAOF, an aim which was to assess the occupational
functioning requirements of healthcare students. The
score achieved when these 3 goal-setting items were in-
cluded, i.e. for the 26-item SAOF constituted our second
performance outcome measure.
2.3.3 Course Satisfaction Survey
The Course Satisfaction survey used at the University of
Haifa was established by Nevo [35] based on the litera-
ture and the similar tools used in other universities in
order to evaluate teaching quality [35]. This standard
survey is part of the University’s routine evaluation sys-
tem to examine student satisfaction at the end of every
course taught at the university. It consists of 22 items that
are rated on a five point scale (1 = low score, 5 = very
high score), with a “not relevant” option. The question-
naire was tested on 11,901 students and on 426 teachers
in 551 courses, within five faculties [35]. This testing
revealed that the items are divided into two distinct fac-
tors: overall satisfaction with the course content and
methods, and satisfaction with the teacher. In the current
study, the students’ overall satisfaction scores served as
the third outcome measure.
2.4 Data Collection and Analysis
Students assessed their occupational functional perform-
ance (using the 23- and 26-item SAOFs) and their learn-
ing styles (using the ILS) on two occasions: once during
the first lesson of the course, and again during the final
lesson. During the final lesson of the course, the students
also completed the course satisfaction survey.
The students were assured that the data would be col-
lected and stored anonymously and utilized solely for
this study and they signed consent forms (N = 40, on
83% participation rate). A student representative distrib-
uted a numerical code to each student that the students
were to use instead of their name on the numerical re-
search tools, viz., the ILS, SAOFs, and the course satis-
faction survey. The list of participants and their corre-
sponding codes was kept confidentially by the students’
representative. Forty students handed in completed ILS
and SOAF forms. However, only 16 course satisfaction
surveys were submitted with anonymous coding (a 40%
completion rate).
All statistical analyses in this study were carried out
using SPSS 14. Descriptive statistics were used to de-
scribe the participants’ characteristics and the scores ob-
Using Problem Based Learning in Training Health Professionals: Should it Suit the Individual’s Learning Style?29
tained from the numerical research tools. The internal
consistencies of these instruments were examined by
Cronbach’s alpha. The Pearson test was used to analyze
correlations between each student’s learning styles and
the three numerical outcome measures of the course: the
total scores for the 23- and 26-item SAOFs and course
satisfaction grade. For interval components and when
analyzing single items, we used the Spearman correla-
3. Results
3.1 Learning Style
The learning styles adopted by students during the course
are summarized in Table 3.
All the scores lay between 5.6 and 6.67, which dem-
onstrates that the students utilized all possible styles dur-
ing the course (sensing and intuitive, visual and verbal,
active and reflective, and sequential and global), with no
single style strongly dominating.
3.2 Occupational Functioning
We validated the adapted 26-item SAOF by conducting a
two-tailed Pearson’s correlation between the items and
factors of the original 23-item SAOF. Significant corre-
lations were found between the new goal-setting factor of
the 26-item SAOF and 1) the “identifying problems and
their solutions” item (#24) (r = 0.96, p < 0.01) of the
23-item SAOF, and 2) the Volition factor (r = 0.44, p <
0.01) of the 23-item SOAF (Table 4), so confirming the
validity of the new “goal setting” factor.
Table 3. Learning styles1 adopted by occupational therapy students
Learning Style Scales Mean Score Standard Deviation Median
Sequential-Global 5.81 2.12 6
Visual-Verbal 6.67 2.87 7
Sensing-Intuitive 5.60 2.57 6
Active-Reflective 6.46 2.51 6
1Learning styles were assessed using the Index of Learning Styles, which comprises four scales. The higher the score for each scale, the closer a per-
son’s earning style is to the first-mentioned term in each pair of styles. A score of 5 to 6 indicates approximately equal usage of both styles
Table 4. Two-tailed pearson’s correlations between learning styles, occupational functioning and satisfaction
of the
of the
(item 24)
Learning Style Scales
Active/Reflective (act_ref) 1
Sensing/Intuitive (sen_int) 0.18 1
Visual/Verbal (vis_ver) 0.08 0.12 1
Sequential/Global (seq_glo) 0.00 0.35* –0.27 1
SAOF Factors
Volition (volition) 0.10 –0.05 0.04 –0.10 0.39* 1
(hab_per = Perform) –0.12 0.33* 0.15 0.11 –0.02 0.46**1
Identifying problems
(item 24) –0.26 –0.35* –0.11 –0.10 0.34* 0.39* 0.29 –0.24 –0.10 1
Setting goals (items 28-30) –0.09 –0.36* 0.04 0.09 0.96**0.44**0.02 0.18 0.23 0.42**
Course Satisfaction Factors
Satisfaction with Course
(Satisfact’ of the course) 0.06 0.10 0.19 –0.56 *0.05 –0.11 –0.38 1
Satisfaction with Teacher
(Satisfact’ of the teacher) 0.09 0.17 0.24 –0.39 0.12 –0.18 0.01 0.71** 1
p < 0.05; **p < 0.01
Copyright © 2010 SciRes. CE
Using Problem Based Learning in Training Health Professionals: Should it Suit the Individual’s Learning Style?
3.3 Course Satisfaction
Our PBL course achieved mean course satisfaction
scores of 4.13 for course content and 4.76 for the teach-
ers, compared with average scores at the University of
Haifa of 3.68 and 4.06, respectively.
3.4 Correlations between Learning Styles,
Occupational Functioning and Satisfaction
Two-tailed Pearson’s tests were used to investigate cor-
relations between different learning styles and our three
numerical outcome measures. The sensing-intuitive
learning style was found to correlate with the habituation
and performance factor of the new (26 items) SAOF (r =
0.33, p < 0.05), while the sequential-global learning style
significantly correlated with course satisfaction (r =
–0.56, p < 0.05).
A significant two tailed Spearman’s correlation was
found between item #24 (identifying problems and their
solutions) and the sensitive-intuitive learning style (r =
–0.35, p < 0.05), and between the scores for our goal
setting factor (items: 28 to 30) and the same sensitive-
intuitive learning style, r = –0.36 (p < 0.05). These cor-
relations indicate that students with an intuitive learning
style appraised themselves as having a significantly
higher ability to identify problems and set goals (Table
4. Discussion
Our research examined the question of whether specific
learning styles correlate with a higher self-evaluation
score by occupational therapy students of their occupa-
tional performance during a PBL course and with greater
course satisfaction. Along the PBL course, students were
exposed to a variety of contexts and activities (i.e. frontal
classes; small groups; meetings with a client in the
community; website forums), which required us, as fa-
cilitators, to adopt a variety of teaching styles, while
challenging the students to adopt a wide range of learn-
ing styles.
Our results show that the students demonstrated all
eight of the learning styles assessed by the ILS and to
about equal extents. The variety of learning styles we
found are similar to those found by previous studies that
were conducted among occupational therapy students
using distant learning [36,30]. In accordance with Felder’s
model, students may show an individual eclectic learning
style rather than a single significant style [25]. This
eclectic style enables students to cope with complexity of
client-therapist process of intervention, in more efficient
way. Although a variety of learning styles manifested
among the students, certain styles were correlated with
different outcomes.
4.1 Correlations between Learning Styles and
4.1.1 Self-Assessed Occupational Functioning
Sensing learning style was found significantly correlated
with better self-assessed habituation and performance.
This finding may indicate that students with sensing
learning style report of higher coping with professional
practical demands such as time organization, routine
flexibility, planning before acting, and communication.
The same characteristic was found by Katz and Heimann
[37], who found that the occupational therapy, nursing,
and social work professions emphasize the concrete
learning mode.
The intuitive learning style significantly correlated
with greater self-assessed abilities to identify problems
and set goals. The adapted 26 SAOF questionnaire,
yielding this finding, supports the contribution of the
additional three items to the original questions. Thus, the
intuitive learning style enables the crucial phase of iden-
tify problems and set goals during intervention, which
was the main goal of the real intervention with a client,
along the course.
Thus, Occupational therapists with intuitive learning
style are capable of intervention application in multidi-
mensional community better then inductive style, which
might address the clients diagnosis only.
4.1.2 Course Satisfaction
Caution is needed in interpreting the course satisfaction
(3rd outcome measure) results due to the small number of
course satisfaction questionnaires that were coded by the
participants. Nevertheless, the current study shows a
global learning style to be significantly correlated with
greater satisfaction with the course content. Global lear-
ners may be able to solve complex problems quickly or
put things together in novel ways once they have grasped
the entire picture [38]. This finding may be related to the
nature of PBL course, which encourages students to be
involved in the learning process and team work, while
using their preferred learning styles, so enabling them to
shine in their areas of expertise and excellence [3]. The
climate within small groups generates opportunities for
sound and open relationships in a collegial, collaborative
A PBL course that incorporates variety styles of teach-
ing, may suit as a good media for transitioning health
care students from the theoretical into the practical edu-
cation, as found by Hammel et al. [20] who made a
qualitative evaluation of students’ perspectives on PBL
in an occupational therapy curriculum. They found that
students who adopted a PBL approach consistently acr-
oss the curriculum contributed to the development of
information management, critical reasoning, communica-
tion, and team-building skills. Those skills are generic
for all health-care students, and are similar to the find-
Copyright © 2010 SciRes. CE
Using Problem Based Learning in Training Health Professionals: Should it Suit the Individual’s Learning Style?31
ings from the SAOF Questionnaire.
4.2 Study Limitations
Student privacy and data anonymity considerations
meant that we were unable to utilize the students’ grades
as a learning outcome measure. Student grades could
potentially be included without compromising data ano-
nymity if external investigators were to conduct future
Our study should be repeated on larger student popula-
tions to increase its validity. The participants in our study
represented the average age of undergraduate students in
our country. However, they were somewhat older than
the norm for undergraduate students in other countries,
and thus our results may be related to the relative matur-
ity of the participating students. Therefore, this study
should be repeated in other countries with younger un-
dergraduate student populations.
5. Conclusions
Problem-based learning methods are particularly benefi-
cial to students having sensing and intuitive learning
styles. Thus, the apparently contradictory findings of
earlier research regarding the efficacy of problem-based
learning methods [9] may indeed have arisen from dif-
ferences in learning styles of the populations surveyed.
Since problem-based and traditional teaching methods
appear to suit different learning styles and to better im-
part different skill sets, they should be regarded as com-
plementary. Our experience of the integrative process
during the new course raised the necessity of imple-
menting the PBL method throughout the whole education
program. The method facilitates the discussion of practi-
cal issues and dilemmas during intervention, as well as
practicing team work. Nevertheless, we developed a tool
for considering which of the professional subjects are
appropriate for the use of the PBL method.
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